Provider Demographics
NPI:1518113703
Name:PARKER, WANDA HOLLAND
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:HOLLAND
Last Name:PARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11402
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-0402
Mailing Address - Country:US
Mailing Address - Phone:585-360-2360
Mailing Address - Fax:
Practice Address - Street 1:105 DR SAMUEL MCCREE WAY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2306
Practice Address - Country:US
Practice Address - Phone:585-360-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10164650164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse